AB1802-HPR PAIN IN AXIAL SPONDYLARTHRITIS MAY NOT BE ALWAYS INFLAMMATORY
Authors: İ. Kurut Aysin, G. Alp, E. Durak Ediboglu, E. Otman Akad, H. Cinakli, E. Erpek, A. Özkan, H. Kocaayan, D. Solmaz, S. Akar
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Many patients with axial spondyloarthritis (axSpA) report persistent pain even when treated with anti-inflammatory agents. Therefore, it can be hypothesized that this persistent pain may not be always entirely of inflammatory origin and additional pain mechanisms may play a role (1) <h3>Objectives</h3> To evaluate the frequency of central sensitization (CS) and neuropathic pain (NP) in patients with axial spondylarthritis (axSpA) and its relationship with disease activity and functional status. <h3>Methods</h3> Patients classified as axSpA according to ASAS 2009 criteria were included in this cross-sectional study. Presence of CS was evaluated with the CS inventory (CSI; a 25-item questionnaire that a score of ≥40 point scored out of 100 is positive for CS. Presence of depression and anxiety were evaluated with Hospital Anxiety and Depression questionnaire (HADS), and fibromyalgia syndrome (FMS) by ACR 2016 criteria. Neuropathic pain (NP) was assessed with DN4 (Douleur Neuropathique en 4 questions) questionnaire. In addition, the patients' BASDAI, ASDAS-CRP, BASFI, ASQoL, ASAS-HI/environmental scores were also calculated. <h3>Results</h3> 121 axSpA patients[102 (84.3%) radiographic axSpA, 74 (61.2%) male, mean age: 43.9 ± 10.6 years] were included in the study. Of our patients 84% were receiving biological therapy. Other characteristics of the patients are summarized in <b>Table 1</b>. CS was detected in 35 (28.9%), NP in 12 (10.1%) and FMS in 9 (7.7%) patients. Age and advanced treatment usage rates were similar between the groups. Among patients with CS the percentage of female was higher, there was no sex difference for patients with NP and FMS. Duration of the disease was shorter in the CS group. Pateints and physician global assessment of disease activity (PGA and PhGA recpectively), BASDAI, Leeds enthesitis <i>index</i> (LEI), ASQoL, ASAS-HI were found to be significantly higher in patients with CS and NP. In addition, BASFI and ASAS-HI environmental scores were worse in those with CS. While anxiety was higher in those patients with CS and NP according to the HADS questionnaire, the rates of depression were similar. Six (17.1%) patients with CS also had NP and 6 (50%) patients with NP had also CS. While all 9 patients with FMS had CS, only 2 had NP. CS severity and disease activity and quality of life scores showed a strong positive correlation <b>(Figure 1</b>). <h3>Conclusion</h3> Approximately one-third of axSpA patients, most of which received advanced therapy, have CS and %10 of them have NP. Both quality of life and activity measures were found to be higher in patients who have CS. Therefore it should be kept in mind that in axSpA patients pain may not be always due to inflammatory origin of the disease, but may be due to non-inflammatory causes of pain. <h3>Reference</h3> [1] Kieskamp, S.C., et al., <i>Central sensitization, illness perception and obesity should be considered when interpreting disease activity in axial spondyloarthritis.</i> Rheumatology (Oxford, England), 2021: p. keab019. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.